16-104785e +_,
City of Federal Way
Community Development Dept.
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 8352607 Fax: (253) 835-2609
FIL.
Project Name: SEA -MAR CLINIC
Project Address: 31405 18TH AVE S
Electrical
Permit #:16 -104785 -00 -EL
Inspection Request Line: (253) 835-3050
Parcel Number: 092104 9233
Project Description: Install and furnish approximately (65) new 6 inch recessed light fixture at exterior soffit. New
circuit wiring to existing relay & control timer.
Owner
Applicant
Contractor
SEA -MAR COMM HEALTH CENTER
SPENCER SAINT THOMASBAZAN
OWNER IS CONTRACTOR
1040 S HENDERSON ST
ARCHITECTS
SEATTLE WA 98108
2000116TH AVE NE SUITE 4
BELLEVUE WA 98034
Additional Permit Information
Is this an Online or O.T.C. application? .................. Yes
PERMIT EXPIRES Thursday, 28 September, 2017
Permit Issued on Wednesday, September 28, 2016
I hereby certify that the above information is correct and that the construction on the above described property
and the occupancy and the use will be in accordance with the laws, rules and regulations of the State of
Washington and the City of Federal Way.
Owner or agent: ORMWN1 ' Date:
"-INALED
THIS CARD IS TO REMAIN ON-SITE
ONV OF a� Construction Inspection Record
Way INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 16104785 00 Address: 3140518TH AVE. S
Project: SEA -MAR COMM HEALTH CENTE FEDERAL WAY WA 98003-5404
Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as possible
(read left to right, top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your inspector if
you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card.
El
UFER Ground (4295)
0
Ditch cover (4030)
®
Slab/Concrete Floor (4255)
Pool Bonding (4195)
UFER Ground (4295)
Temporary Power (4275)
Ditch cover (4030)
Service (4235)
Slab/Concrete Floor (4255)
Date
By
Date
By
Date
By
Date
Date
®
Pool Bonding (4195)
0
Temporary Power (4275)
®
Service (4235)
Pool Bonding (4195)
113Y
Temporary Power (4275)
Service (4235)
By
Date
By
Date
By
Date
Q
Feeders/Sub-panels (4045)
®
Rough Electrical (4225)
®
Ceiling Cover (4020)
Feeders/Sub-panels (4045)
113Y
Rough Electrical (4225)
Ceiling Cover (4020)
By
Date—
Date[k((J tfV
By
Date
�o Final - Electrical (4055)
Final - Electrical (T)
By Date b
Rough Electrical
Final Electrical
Right of Way
113Y
Approved
Approved
Approved
Date
By
Date
I By
Date
40k
CITY OF
Federal Way
RECEIVED
SEP 2 7 2016
CITY OF FEDERAL WAX
CDS
ELEC'T'RICAL
PERMIT APPLICATION
PERMIT NUMBER _1 _ n q "7 �,�5 _
SITE ADDRESS'
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SUITE/UNIT/SPACE #
PROJECT VALUATION
$ qt5()a
ASSESSORS TAX/PARCEL #
1 o ct3_
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
s �. fY` j �� W C"N,C,
1 CA
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PROJECT DESCRIPTIONT
<S IT' CA9-f- ! l 1T- (A kV-t(Jk;�,
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
syr- C p (-1 1 ft'�7mj-ft
( ) -
MAILING ADDRESS
E-MAIL
CITY
sv;A�16
STATE
W/v-
I ZIP
FAX
NAAMMEE
PRIMARY PHONE
r7
-
MAILING ADDRESS
1040
E-MAIL
ELECTRICAL
CONTRACTOR
CITY
1L-
STATE
v)�
ZIP
�L
FAX
( ) -
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
PRIMARY PHONE
MAILING ADDRESS204 I�
,O
CITY
STATE
ZIP Tam
AX
PROJECT CONTACT
NAME
U!04v—,
PRIMARY PHONE
07 - b3
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner. I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in
the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the city,
but only where su ses out o liance of the city, including its officers and employees, upon the accuracy of the
informatio plied to the city as a part of this ap ication.
SIGNATURE:
L�-
TE
Bulletin # 160 - April 14, 2016 Page 1 of 1 Ul-landouts\Electrical Permit Application